POS1136 OSTEOARTHRITIS AND METHOTREXATE: EFFICACY AND SAFETY.
Authors: L. Alekseeva, E. Strebkova, N. Kashevarova, E. Taskina, E. Sharapova, D. Kusevich, A. Lila
Journal: Annals of the Rheumatic Diseases (2022)

Background One of the common phenotypes of osteoarthritis (OA) is the “inflammatory phenotype,” which is characterized by persistent synovitis of knee joints, small joints of the hands, the development of the erosive hand OA (EOA), and insufficient effectiveness of standard OA therapy. In the inflammatory OA phenotype, changes observed in the synovial sheath have similar features to rheumatoid arthritis, so baseline anti-inflammatory drugs used in RA may be considered as possible treatments for OA. The literature presents few studies with mixed results on the use of methotrexate (MTX) in patients with OA. Objectives To examine the efficacy and safety of MTX use in patients with inflammatory knee OA and hand EOA. Methods The study included 40 patients (women) with OA (according by ACR criteria) and insufficient effectiveness of previous OA standard therapy: with knee OA (47.5%), hand EOA (25%) and a combination of these 2 localizations (27.5%). The clinical characteristics are shown in Table 1. For 24 weeks, patients received MTX subcutaneously with a dose escalation of 10mg to 15mg per week combined with folic acid 5mg per week and meloxicam 15mg “on demand.” The efficacy of MTX therapy was assessed by WOMAC and AUSCAN, by the OMERACT-OARSI criteria. During the study, laboratory indicators were monitored (clinical, biochemical, immunological blood tests, general urine test). Table 1. Clinical characteristic of patients. Parameters Values Age, y.o., Me [25%; 75% percentiles] 62.5 [58;69] Аge of OA onset, y.o., Me [25%; 75% percentiles] 51.0 [46;58] Duration of disease, years, Me [25%; 75% percentiles] 9.53 [5;15] Kellgren-Lawrence grades of knee OA II grade, % 73.3% III grade, % 26.7% BMI, kg/m 2 (М ± δ) 30.68±6.48 WOMAC pain, mm, Me [25%; 75% percentiles] 328 [236; 360] WOMAC stiffness, mm, Me [25%; 75% percentiles] 100 [87;121] WOMAC functional insufficiency, mm, Me [25%; 75% percentiles] 776 [610; 1019] Total WOMAC, mm, Me [25%; 75% percentiles] 1220 [819; 1640] AUSCAN pain, mm, Me [25%; 75% percentiles] 235 [191;313] AUSCAN stiffness, mm, Me [25%; 75% percentiles] 56 [35;66] AUSCAN functional insufficiency, mm, Me [25%; 75% percentiles] 430 [334;580] Total AUSCAN, mm, Me [25%; 75% percentiles] 671 [392;912] ESR, mm/h, Me [25%; 75% percentiles] 11 [7;13] CRP, mg/l, Me [25%; 75% percentiles] 1.3 [0.8;2.5] Results As a result of 24 weeks of MTX therapy, there was a statistically significant decrease in pain, stiffness and functional insufficiency in the small joints of the hand on the AUSCAN index and in the knee joints on the WOMAC index (Figure 1). In hand EOA, there was a decrease in pain by 40.21%, stiffness by 48.21%, functional insufficiency by 23.72%. In knee OA, there was a reduction in pain by 50.45%, stiffness by 49%, and functional failure by 42.7%. 85.5% of patients with knee OA and 72.5% of patients with hand EOA became responders to therapy according to the OMERACT-OARSI criteria. The best clinical effect was achieved in knee OA (89.9% of patients). As a result of MTX therapy, the need for non-steroidal anti-inflammatory drugs (NSAID) decreased: initially, 85% of patients took NSAID daily or more than 3 times a week, and after 6 months of MTX therapy, only 15% of patients took NSAID daily. In general, the tolerability of MTX was satisfactory. The study of 7 patients was stopped: 4 (10%) due to nausea, 3 (8%) due to a moderate increase in transaminases, one of these patients (3%) had one episode of neutropenia up to 1.82x10*9/l (norm 2.04 - 5.80 x10*9/l). There were no serious adverse events. Figure 1. Conclusion The results demonstrated a good symptomatic effect of MTX in patients with knee OA and hand EOA. There was a statistically significant decrease in pain, stiffness and functional insufficiency in knee joints and small joints of the hands, a decrease in the need for NSAID throughout MTX therapy. The best clinical effect was achieved in patients with knee OA. Thus, the study showed that MTX has a good clinical effect in OA and a satisfactory safety profile. Disclosure of Interests None declared